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Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study.

ABSTRACT: BACKGROUND:The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care. METHODS:Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients' demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses. RESULTS:The participants' mean age was 78.8?±?10.8?years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (??=?1.74) had high baseline QOL scores (??=?0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a ?-value of -?1.24 in the pre-bedridden group and?-?1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (??=?0.50) and Mini-Nutritional Assessment-Short-Form scores (??=?0.37) were found to have positive associations with the QOL rating. CONCLUSIONS:For the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.

SUBMITTER: Huang CH

PROVIDER: S-EPMC6345012 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study.

Huang Chi-Hsien CH Umegaki Hiroyuki H Kamitani Hiroko H Asai Atushi A Kanda Shigeru S Maeda Keiko K Nomura Hideki H Kuzuya Masafumi M

BMC geriatrics 20190124 1

<h4>Background</h4>The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care.<h4>Methods</h4>Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up pe ...[more]

PMID: 30678632

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Project description:RationaleUnderstanding long-term outcomes of critically ill patients may inform shared decision-making in the intensive care unit (ICU).ObjectivesTo quantify 6-month functional outcomes of general ICU patients, and develop a multivariable model comprising factors present during the first ICU day to predict which patients will return to their baseline function 6 months later.MethodsWe conducted a prospective cohort study in three medical ICUs and two surgical ICUs in three hospitals. We enrolled patients who spent at least 3 days in the ICU and received mechanical ventilation for more than 48 hours and/or vasoactive infusions for more than 24 hours.ResultsWe measured 6-month outcomes including survival, return to original place of residence, and physical and cognitive function. Of 303 enrolled patients, 299 (98.7%) had complete follow-up at 6 months. Among the 169 patients (56.5%) who survived to 6 months, 82.8% returned home, 81.9% were able to toilet, 71.3% were able to ambulate 10 stairs, and 62.4% reported normal cognition. Overall, 31.1% of patients returned to their baseline status on these measures. Factors associated with not returning to baseline included higher APACHE III score, being a medical patient, older age, nonwhite race, recent hospitalization, prior transplantation, and a history of cancer or of neurologic or liver disease. A model including only these Day 1 factors had good discrimination (area under receiver operating characteristic curve, 0.778; 95% confidence interval, 0.724-0.832) and calibration (difference between observed and expected P value, 0.36).ConclusionsAmong patients spending at least 3 days in an ICU and requiring even brief periods of life-sustaining therapy, nearly one-half will be dead and less than one-third will have returned to their baseline status at 6 months. Of those who survive, the majority of patients will be back at home at 6 months. Future research is needed to validate this multivariable model, including readily available patient characteristics available on the first ICU day, that seems to identify patients who will return to baseline at 6 months.

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Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study.

Publications

Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study.

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